Zhongguo cuzhong zazhi (Jun 2023)

任务导向性训练治疗卒中后患者平衡功能康复效果的meta分析 Meta-analysis of the Effect of Task-oriented Training on Balance Function Rehabilitation in Patients after Stroke

  • 程雅琴，温春娣，陈晓娜，陈艳君，陈星星

DOI
https://doi.org/10.3969/j.issn.1673-5765.2023.06.007
Journal volume & issue
no. 6
pp. 660 – 669

Abstract

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目的 通过meta分析对比任务导向性训练（task-oriented training，TOT）与常规康复训练治疗卒中后患者平衡功能的疗效差异，探讨TOT治疗卒中患者平衡功能的效果。 方法 计算机检索Embase、PubMed、Cochrane、Web of Science以及中国知网、万方、维普数据库中从建库至2022年12月正式发表的关于TOT对卒中平衡功能影响的随机对照试验。结局指标包括Berg平衡量表（Berg balance scale，BBS）、起立-行走计时测试（timed up and go test，TUGT）、改良Barthel指数（modified Barthel index，MBI）、6分钟步行测试（6 minute walk test，6MWT）以及Fugl-Meyer评定量表下肢部分（Fugl-Meyer assessment-lower extremity，FMA-LE）。由两名研究者独立筛选文献，使用Cochrane偏倚风险评估工具评估文献质量并提取数据，采用RevMan 5.4软件对各项指标进行meta分析。 结果 本研究共纳入9项随机对照试验，包括474例受试者，其中TOT组238例，对照组（常规治疗）236例。meta分析结果显示，TOT组BBS评分（MD 4.11，95%CI 2.76～5.45，P＜0.001），TUGT评分（MD -3.24，95%CI -4.72～-1.75，P＜0.001），MBI评分（MD 9.55，95%CI 5.05～14.05，P＜0.001），FMA-LE评分（MD 3.92，95%CI 2.50～5.35，P＜0.001）与对照组相比，差异均有统计学意义，TOT组的改善更显著。在6MWT方面，TOT组与对照组的改善差异无统计学意义。 结论 TOT能改善卒中后患者的平衡控制能力，且比常规训练更有效，对患者下肢运动功能、功能灵活性和日常生活活动能力方面也有积极的影响，但对心肺功能无显著影响。 Abstract: Objective To compare the efficacy of task-oriented training (TOT) and conventional rehabilitation training in the treatment of balance function in post-stroke patients by meta-analysis, and to explore the effect of TOT on balance function in patients with stroke. Methods Randomized controlled clinical trials on the effects of TOT on stroke balance function were retrieved from Embase, PubMed, Cochrane, Web of Science, CNKI, Wanfang and VIP databases from the establishment of database to December 2022. Outcome measures included Berg balance scale (BBS), timed up and go test (TUGT), modified Barthel index (MBI), 6 minute walk test (6MWT) and Fugl-Meyer assessment-lower extremity (FMA-LE). Two researchers independently screened the literature, used the Cochrane bias risk assessment tool to assess the quality of the literature and extracted the data, and used RevMan 5.4 software for meta-analysis of each indicator. Results A total of 474 subjects were included in 9 randomized controlled trials, including 238 in the TOT group and 236 in the control group (conventional treatment). The results of meta-analysis showed that the BBS score (MD 4.11, 95%CI 2.76-5.45, P<0.001), TUGT score (MD -3.24, 95%CI -4.72- -1.75, P<0.001), MBI score (MD 9.55, 95%CI 5.05-14.05, P<0.001), FMA-LE score (MD 3.92, 95%CI 2.50-5.35, P<0.001) in TOT group were significantly different from those in control group. The improvement was more significant in the TOT group. There was no significant difference in the improvement of 6MWT between TOT group and control group. Conclusions TOT can improve the balance control ability of post-stroke patients, and is more effective than routine training. It also has a positive effect on lower limb motor function, functional flexibility and activities of daily living, but has no significant effect on cardiopulmonary function.

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